Characteristics of nausea and vomiting in pregnant Japanese women

Nausea and vomiting in pregnancy (NVP) is a common condition in early pregnancy. The purpose of this study was to clarify the characteristics of Japanese women's NVP and to determine the relationship between NVP and quality of life. The NVP was measured using the Rhodes' Index and quality of life was measured by the SF-36. Nausea and retching at 4-7 and 12-15 weeks was significantly more severe than at 16-19 weeks, whereas there was no difference in vomiting. A decrease in physical well-being was correlated with the severity of nausea and retching at 8-11 and 12-15 weeks, but not with that of vomiting at any gestational period. Although the symptom of vomiting tended to be noticed more frequently, nausea and retching was more important in the care and treatment of NVP in Japanese women than vomiting, suggesting that professionals should carefully measure NVP symptoms using reliable instruments.     

Factors associated with the feeling of stability in the daily life among colostomy patients

Aim: Colostomy patients must lead a stable life after discharge. However, little is known about the feeling of stability in the daily life of these patients. The purpose of the present study was to identify the associated factors. Methods: The subjects were outpatients who met all of the following criteria: (i) a permanent colostomy for the treatment of colonic, rectal, or anal cancer; (ii) under 80 years of age; (iii) a colostomy history of less than 10 years; and (iv) no significant prior physical or psychiatric disorders. Data were collected by conducting interviews using a questionnaire, examining medical records, and asking the nurses responsible for patients’ care. The following measures were evaluated: patients’ feeling of stability in the daily life, patients’ characteristics, physical condition, support resources, self‐evaluation of their current life, and hospital characteristics. Statistical analysis was performed using t‐tests, Spearman's rank correlation coefficients, and structural equation model. Results: Data from 133 patients were available for analysis. The final model fitted the data well. All estimated parameters were significant. The opportunity to attend periodic stoma clinics and support from nurses contributed to the feeling of stability in the daily life and had a positive effect on patients’ self‐evaluation of their current life. Conclusions: The results of this study corroborated the necessity for an outpatient support system to enhance the feeling of stability in the daily life after hospital discharge. This finding supports the need to improve stoma care systems and to make such systems more available.     

The incidence of nausea and vomiting of pregnancy (NVP): a comparison between depressed women treated with antidepressants and non-depressed women

BACKGROUND: Nausea and vomiting of pregnancy (NVP) affects up to 80% of pregnant women. In many cases NVP causes changes i n family, social, o roccupational functioning. Several studies have linked NVP with depression; however, whether depression preceded or resulted from NVP, has not been established. OBJECTIVE: To examine whether pregnant women, diagnosed with depression pre-conceptionally, treated with an antidepressant, reported a higher incidence of NVP when compared with pregnant women without depression. METHOD: In this pilot study, two groups of pregnant women who called the Motherisk Program in Toronto, Canada, were compared. Group 1 was comprised of 179 pregnant women who reported taking an antidepressant for the treatment of depression prior to pregnancy and in the first trimester. Group 2 was comprised of 179 pregnant women with no history of depression. The incidence of NVP in both groupswas recorded and compared. RESULTS: In the depressed group 109/179 (61%) women reported suffering from NVP vs.121/179 (68%) in the non-depressed group (P = 0.1). The logistic regression analysis did not identify any independent variable as significantly explaining NVP. CONCLUSION: Depression and treatment with antidepressants prior to and in early pregnancy, does not appear to affect the incidence of NVP.     

Management of back and neck pain: who seeks care from physical therapists?

BACKGROUND AND PURPOSE: Little information is available on factors associated with physical therapist use by people with back or neck pain. Identifying the characteristics of people who seek care from physical therapists is a useful first step in determining whether there is appropriate use of physical therapy services. The purpose of this study was to identify factors associated with physical therapist use by people with back or neck pain. SUBJECTS: The subjects were 29,049 people who had back pain or neck pain, or both, and who were seen for an initial evaluation at 1 of 21 US spine care centers. Each subject and evaluating physician completed a written survey at the time of the initial evaluation. METHODS: Multiple logistic regression analyses were conducted to identify factors associated with physical therapist use. RESULTS: Several measures of health and illness severity were associated with physical therapist use. Age and being male were negatively associated with physical therapist use. Education level, having workers' compensation coverage, and being in litigation were positively associated with physical therapist use. Physical therapist use also varied by previous physician use and census region. DISCUSSION AND CONCLUSION: The results suggest that variations in physical therapist use are associated with factors other than health and illness severity. The results also suggest that people who would benefit from physical therapy may not be receiving it or that people who would not benefit from physical therapy are receiving it, or both.     

Nausea in pregnancy: attitudes among pregnant women and general practitioners on treatment and pregnancy care

Objective: Nausea and vomiting during pregnancy (NVP) is very common, and may have great impact on a woman’s life. The aim of this study was to explore thoughts and attitudes among Norwegian pregnant women and GPs on treatment of NVP and pregnancy care. Design: Focus-group study. Setting and subjects: Separate focus-group discussions were conducted with pregnant women and GPs. Results: Two focus-group discussions were conducted with pregnant women and two with GPs. The GPs thought it was important to normalize NVP symptoms. However, the women felt their distress due to NVP was trivialized by the GPs. The women were sceptical towards the use of medicines while pregnant, and avoidance was sought despite being ill. The GPs appeared uncertain with respect to medical treatment of NVP, which was stated to be considered only after progression to quite severe symptoms. Sick leave seemed to be an important part of the treatment regime applied by the GPs. The women had good experiences with graded sick leave. Conclusion: This Norwegian study identifies attitudes among GPs and pregnant women that may act as obstacles to appropriate care for women with NVP. The pregnant women and the GPs seemed to talk at cross-purposes; GPs’ normalization of the symptoms made the women feel that their distress due to NVP was trivialized by the GPs. Our results indicate that pregnant women with NVP requiring medical treatment probably need comprehensive and reassuring information about treatment options before considering using any medicines.

• Key points

• Nausea and vomiting during pregnancy (NVP) is very common, and considered to be of clinical significance for 35% of women.

  • While the GPs agreed on the importance of normalizing the symptoms, the women felt their distress was trivialized, and missed being properly evaluated.

  • Both the GPs and the women showed a reluctant attitude to medical treatment of NVP.

  • The GPs gave the impression of considering medical treatment only after progression of symptoms to becoming quite severe.

     

Physical therapy use by community-based older people

BACKGROUND AND PURPOSE: Little information is available on factors associated with physical therapy use. Identifying the characteristics of people who use physical therapy and some of the factors associated with its use is a useful first step in determining whether disparities exist in physical therapy use. The purpose of this study was to identify factors associated with physical therapy use by community-based older people. SUBJECTS: The subjects were community-based people 65 years of age or older who participated in the Medicare Current Beneficiary Survey and had at least one physician encounter (N=38,312 person-years across 20,227 individuals). METHODS: Logit and ordinary least squares regression analyses were conducted to identify factors associated with physical therapy use. RESULTS: Several measures of health and function were associated with physical therapy use. Several demographic, insurance, and geographic characteristics also were associated with physical therapy use. Income, education, having supplemental private insurance, participating in a managed care plan, and physical therapist supply were positively associated with physical therapy use. Age was negatively associated with physical therapy use. For people who saw a physical therapist, amount of physical therapy received was positively associated with income, having supplemental private insurance, living in a metropolitan area, physical therapist supply, and being African American. Amount of physical therapy received was negatively associated with being in a managed care plan. DISCUSSION AND CONCLUSIONS: Variation in physical therapy use, explained by factors other than need, suggests potential underuse or overuse of physical therapy by community-based older people.     

Headache in the Elderly: An Evaluation of Risk Factors

SYNOPSIS
Information on the prevalence of headache in an ambulatory elderly population was collected from 1,284 participants in a health screening program in Dunedin, Florida. Association between headache and possible risk factors including age, sex, reported symptoms and diseases, drug use, physical characteristics, and sleep patterns were studied. Eleven percent of women and 5 percent of men reported frequent headaches. There was no relationship between age and reported headache in this elderly population. The most commonly reported positions for headache were frontal (35.2 percent) and all over (29.7 percent). In women there was a significant correlation between headache and the total number of other diseases and symptoms reported (p<0.0001). However, in men, there was no such correlation. Numerous specific symptoms were found to be associated with headache in women including: temporary loss of vision, expressive aphasia, and feeling that others do not care. In men, headache was significantly correlated only with paroxysmal nocturnal dyspnea, feeling lonely, and feeling depressed, Subjects who slept less than seven hours a day reported a greater prevalence of headache (13.5 percent) than those who slept more than seven hours (8.1 percent) (p<0.01). There was no correlation of headache with systolic or diastolic blood pressure, coffee, alcohol or tobacco use, or the amount of time spent watching television. Elderly headache sufferers, in summary, often have other conditions coexisting with and/or contributing to the headaches. Some of these conditions may respond to psychological or medical intervention.     

Factors that affect the duration of wearing disposable personal protective equipment by healthcare professionals in Wuhan during treatment of COVID‐19 patients: An epidemiological study

The purpose of this study of healthcare workers who cared for COVID‐19 patients was to identify factors that affected the duration of wearing personal protective equipment (PPE). The results of this study will provide initial guidance to practicing clinicians and a foundation for further research on this topic. This cross‐sectional study examined 139 frontline healthcare professionals who worked at a single hospital in Wuhan, China, from March 16 to April 1, 2020. General and demographic data, physical and mental status, use of personal protective equipment, type of hospital work, and duration of wearing personal protective equipment were recorded. The mean duration of wearing personal protective equipment was 194.17 min (standard deviation: 3.71). Multiple linear regression analysis indicated that the duration of wearing personal protective equipment was significantly associated with the presence of a chronic disease, working hours when feeling discomfort, lack of patient cooperation and subsequent psychological pressure, prolonged continuous wearing of personal protective equipment, feeling anxious about physical strength, and the presence of fatigue when wearing personal protective equipment. These factors should be considered by practicing healthcare professionals and in future studies that examine the optimal duration of wearing personal protective equipment.     

Prevalence and severity of nausea and vomiting of pregnancy and effect of vitamin supplementation.

OBJECTIVE: Although nausea and vomiting of pregnancy is the most common medical condition during pregnancy, there are many unanswered questions regarding its cause, epidemiologic features and optimal management. The objectives of this study were to ascertain the prevalence of nausea and vomiting in a sample of Canadian women, to characterize the distribution of their severity and to investigate the role of vitamin B6 deficiency in their etiology. DESIGN: Prospective study. SETTING: Antenatal counselling service for pregnant women. PATIENTS: Three cohorts of women: a prospective, population-based cohort of 193 women, to estimate the rate and severity of nausea and vomiting (cohort A); a cohort of 555 women who sought advice for nausea with or without vomiting, to study the correlation between the maximal daily number of episodes of vomiting and maximal weight loss (cohort B); and a prospective cohort of 301 women who reported vomiting, to correlate vitamin supplementation with vomiting (cohort C). INTERVENTIONS: All 3 cohorts were interviewed during the counselling session, and cohort B was followed up prospectively. OUTCOME MEASURES: Frequency of nausea and vomiting, weight loss, maximal number of daily episodes of vomiting, rate of multivitamin supplementation. RESULTS: Overall, 67% of the women in cohort A reported experiencing nausea or vomiting, or both; 22% reported vomiting, and 9% experienced weight loss. In cohort B there was a significant correlation between the maximal number of daily episodes of vomiting and maximal weight loss, although there was wide variation (r2 = 0.25, p < 0.001). There was a highly significant correlation between the number of daily vomiting episodes and mean weight loss (r2 = 0.99). In cohort C, vomiting was significantly associated with lack of supplementation with multivitamins before 6 weeks' gestation (p = 0.002). CONCLUSIONS: The relation between number of daily vomiting episodes and mean weight loss may serve as a clinical tool to assess the severity of nausea and vomiting in pregnancy and the success of anti-emetics and rehydration regimens. Further study is needed to elucidate the biologic basis of the observed association between vomiting and lack of multivitamin supplementation in early pregnancy.     

Factors Influencing Admission among Children with a Traumatic Brain Injury

OBJECTIVES: To describe the epidemiology of traumatic brain injury (TBI) among children in Maryland and to examine factors that influence hospital admission. METHODS: Statewide mortality, hospital discharge, and ambulatory care data were used to identify all TBI-related emergency department (ED) visits, hospitalizations, and deaths that occurred in 1998 to children aged 0-19 years according to the Centers for Disease Control and Prevention's standard case definition and protocol. Inpatient admission was modeled as a function of patient, injury, and hospital characteristics. RESULTS: The overall incidence of pediatric TBI (i.e., ED visits, hospitalizations, and deaths) in 1998 was 670/100,000. After controlling for injury severity and other factors, uninsured children were 40% less likely to be hospitalized (95% CI = 0.43 to 0.82) and children with Medicaid were 90% more likely to be hospitalized (95% CI = 1.42 to 2.54) than were those with private insurance. The presence of a major associated injury significantly influenced the likelihood of hospitalization, especially among children with a minor (OR = 8.8) to moderate (OR = 11.6) TBI. Children who presented to a trauma center hospital were significantly more likely to be hospitalized than children treated at a non-trauma center hospital, although this varied depending on income (OR = 1.8 for high versus low) and hospital volume (OR = 2.6 for a small hospital and OR = 29.0 for a large hospital). CONCLUSIONS: After adjusting for TBI severity and the presence of associated injuries, significant differences in hospitalization rates may exist among different patient subgroups and hospitals for children who sustain TBIs.     

Patients' experiences of laparoscopic cholecystectomy in day surgery

Previous research has concentrated mainly on surgical aspects and postoperative complication rates after day surgery laparoscopic cholecystectomy (LC), and less on patients' experiences and nursing care aspects. A qualitative study was conducted aimed at investigating patients' experiences of LC in day surgery. Ten women and two men were interviewed. The material was coded, categorized and analysed using qualitative analysis. The findings demonstrate that individuals with gallstone disease experience limitations in their daily life and feelings of socially handicapped. Prior to surgery, the patients felt anxious and expressed a wish for tranquilizers, and to meet the surgeon responsible. At discharge after day surgery, amnesia was experienced and the respondents did not remember important information about the operation given by the surgeon. Experience of postoperative pain varied greatly. Several respondents had a relapse of pain on the third day lasting up to 1 week. The need for additional pain medication and a bloated feeling were reported. Some respondents reported nausea and vomiting, and most had questions about wound care. The need for additional telephone follow-up was mentioned, as was the fact that it was difficult to come home to small children. However, the great majority felt that returning home on the same day as the operation, was positive.     

癌症患儿症状体验的现况调查

目的:评估和描述癌症患儿症状的发生率、频率、严重度和困扰度。方法:对125名4岁及以上的癌症患儿使用记忆症状量表进行自我评估或家长代评。结果:其症状发生率从1.6%(吞咽困难)到76.8%(出汗);最常发生(发生率≥40%)的症状包括:出汗、缺乏体力、没有食欲、急躁易怒、疼痛、恶心、感到紧张、体重下降、口干和咳嗽;在发生率<40%的症状中,困扰度较高(≥40%)的症状包括:小便有问题、吞咽困难、呕吐和口腔溃疡。处于治疗期的患儿其症状出现数量(11.35±4.10)多于未开始治疗或休疗的患儿(8.15±4.43),且不同治疗状态患儿的生理症状维度得分和总得分上差异有统计学意义(P<0.01)。结论:癌症患儿症状普遍存在,且极易受各种身心症状的困扰。运用多维的工具进行系统性的症状评估,可获得更多关于症状体验方面的信息,进而有利于医护人员更加有针对性地采取干预措施,以完善护理实践。     

What were the outcomes of home follow-up visits after postpartum hospital discharge?

OBJECTIVES: To assess health outcomes of home follow-up visits after postpartum discharge and assess relationships between the number of home visits and selected outcomes among women who gave birth at two Queensland, Australia, regional hospitals. DESIGN: A cross sectional study. Services provided during the home visits were responsive to a woman's need rather than having a structured protocol of services. MAIN OUTCOME MEASURES: The four measured health outcomes were: 1) postpartum depression; 2) confidence to undertake maternal roles; 3) breastfeeding; and, 4) satisfaction with postpartum care. RESULTS: Of 210 women who were invited to participate in the study, 143 (68.1%) provided information. Women who received a higher number of home visits had significantly lower confidence to undertake maternal roles than those who received fewer home visits. There was a positive correlation between the number of home follow-up visits and postpartum depression among women who gave birth at one hospital (Hospital B), but not at the other (Hospital A). No relationship was found between the home postpartum visits and the other outcomes. CONCLUSION: These results could be explained in that home follow-up visits were offered to all women at Hospital A while Hospital B only provided home visits to women who had a health risk due to their social, physical and psychological characteristics. The lack of protocol home visits and the characteristics of women receiving the visits were probably the major factors which influenced these limited beneficial outcomes.     

Patient falls in the acute care setting: identifying risk factors

A retrospective comparative chart audit was conducted to identify patient characteristics associated with falls in the acute care setting, to examine the extent to which the significant characteristics explained if falls occurred, and to test the ability of variables believed to be risk factors to predict falls. Patients aged 60 and older who fell during hospitalization (n = 331) were compared with a random sample of patients aged 60 and older who were hospitalized during the same time period but did not fall (n = 300). Two days of documentation were sampled: admission day and day preceding the fall for the fall group, and admission day and a random day of hospital stay for the no-fall group. Findings supported the idea that fall-prone patients can be identified and that significant differences between those who do and do not fall are evident at hospital admission. The findings also suggested an alteration in the constellation of characteristics nurses use to identify fall-prone patients. Of 11 variables representing standard risk factors, only 6 were significantly related to fall status; 5 entered the regression equation as significantly contributing to the 22% explained variance. When potential predictor variables were expanded to include additional patient characteristics, the explained variances for fall status were 31% from the admission day data and 34.5% from the fall/random day data.     

Determinants of antenatal care utilization in three rural areas of Vietnam

OBJECTIVE: To identify factors associated with any use of antenatal care (ANC), gestational age at entry to ANC, number of visits, and overall ANC utilization in the three provinces of Long an, Ben tre, and Quang ngai. DATA: The Vietnam-Australia Primary Health Care Project conducted cross-sectional surveys in 1998-1999. Data from 1,335 eligible women were available for analysis. METHODS: Explanatory variables were selected using the Andersen Health Seeking Behavior Model and analyzed using multivariate regression techniques. RESULTS: External environment, predisposing characteristics, and need, which existed before contact with ANC providers, were most related to using any ANC and gestational age at entry to ANC. However, ANC services provided to women and personal health care during pregnancy, which could have resulted from initial contact with ANC providers, were most related to continuation of ANC visits and overall ANC utilization. Significant variability in the use of ANC existed between provinces and between subsets of women in each province. CONCLUSION: To have more women who attend ANC and attend early, promotion should be targeted at high-risk groups of women. However, to improve the number of ANC visits and overall utilization, the quality of ANC services should be improved.     

Long-term mortality and quality of life after prolonged mechanical ventilation

OBJECTIVE: To describe and identify factors associated with mortality rate and quality of life 1 yr after prolonged mechanical ventilation. DESIGN: Prospective, observational cohort study with patient recruitment over 26 months and follow-up for 1 yr. SETTING: Intensive care units at a tertiary care university hospital. PATIENTS: Adult patients receiving prolonged mechanical ventilation. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We measured mortality rate and functional status, defined as the inability to perform instrumental activities of daily living (IADLs) 1 yr following prolonged mechanical ventilation. The study enrolled 817 patients. Their median age was 65 yrs, 46% were women, and 44% were alive at 1 yr. Median ages at baseline of 1-yr survivors and nonsurvivors were 53 and 71 yrs, respectively. At the time of admission to the hospital, survivors had fewer comorbidities, lower severity of illness score, and less dependence compared with nonsurvivors. Severity of illness on admission to the intensive care unit and prehospitalization functional status had a significant association with short-term mortality rate, whereas age and comorbidities were related to long-term mortality. Fifty-seven percent of the surviving patients needed caregiver assistance at 1 yr of follow-up. The odds of having IADL dependence at 1-yr among survivors was greater in older patients (odds ratio 1.04 for 1-yr increase in age) and those with IADL dependence before hospitalization (odds ratio 2.27). CONCLUSIONS: Mortality rate after prolonged mechanical ventilation is high. Long-term mortality rate is associated with older age and poor prehospitalization functional status. Many survivors needed assistance after discharge from the hospital, and more than half still required caregiver assistance at 1 yr. Interventions providing support for caregivers and patients may improve the functional status and quality of life of both groups and thus need to be evaluated.     

Predicting place of death of elderly cancer patients followed by a palliative care unit

To determine the predictors of death outside the palliative care system for elderly cancer patients who were followed by a palliative care unit (PCU), a retrospective review of 199 charts was performed. Comorbidities, current neoplastic disease (location of tumor, months since diagnosis, number of days of PCU follow-up), symptoms, drug use, and social support were recorded. Place of death was not significantly different among sexes. Factors predicting death in the general hospital for men were digestive comorbidities, vomiting, and weakness. For women, disease of the senses was predictive. Although there were no significant differences with respect to place of death between sexes in an older cancer population followed by a PCU, the factors that predicted which patients will die in the hospital for men were generally related to their medical condition, whereas the predictive factors for women were mainly related to functional dependency and social support. Social support had a trend towards predicting the place of death in women.     

Mortality of patients with heatstroke admitted to intensive care units during the 2003 heat wave in France: a national multiple-center risk-factor study

OBJECTIVE: Heatstroke requires active body cooling and organ failure supportive care. Although heat waves are expected to recur over the next decades, little is known about the risk factors for mortality in heatstroke patients. We examined the prognosis and risk factors for hospital mortality in patients with heatstroke admitted to an intensive care unit (ICU) during the heat wave in France in August 2003. DESIGN: A questionnaire was sent to the physicians leading an ICU in France to identify the patients admitted with heatstroke during August 2003. Data included demographics, factors predisposing to heatstroke, severity during the first day in the ICU, air conditioning in the ICU, and hospital mortality. Risk factors for mortality were determined in multivariate Cox proportional hazards analysis. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Data were obtained for 345 patients. Hospital mortality was 62.6%. Occurrence of heatstroke at home or in a healthcare facility rather than in a public location, high Simplified Acute Physiology Score II, high body temperature, prolonged prothrombin time, use of vasoactive drugs within the first day in the ICU, and patient management in an ICU without air conditioning were independently associated with an increased risk of death. CONCLUSIONS: Mortality of patients admitted to the ICU with heatstroke is high. Predictors of mortality are available within the first 24 hrs after admission. Furthermore, in this study, air conditioning in the ICU was associated with improved outcome.     

Prevalence of leg wound complications after coronary artery bypass grafting: determination of risk factors.

BACKGROUND: The reported prevalence of leg wound complications after coronary artery bypass grafting is 2% to 24%. Decreased length of hospital stay for patients who have this surgical procedure poses new care requirements in both acute care and community settings. OBJECTIVE: To determine the prevalence of postoperative leg wound complications in patients undergoing coronary artery bypass grafting and the risk factors associated with these complications. METHOD: In this prospective, observational study, 547 consecutive patients who had coronary artery bypass grafting alone or in combination with other cardiac surgical procedures were examined for evidence of leg wound complications each day after surgery during hospitalization. After discharge, problems were detected by home care nurses. RESULTS: The prevalence of leg wound complications was 6.8%. Factors significant by multiple logistic regression included preoperative hospitalization, use of an Ace elastic bandage in the operating room, the length of time the leg incision remained open in the operating room, and administration of nicardipine intravenously in the intensive care unit. Odds ratios were calculated for each variable. Premorbid factors such as diabetes or peripheral vascular disease were not predictive of complications. On average, most problems occurred on postoperative day 10, when many patients were at home. CONCLUSIONS: The results highlight the need to detect complications early, in both the hospital and the community settings. The determination of factors related to poor outcomes may assist clinicians in improving healthcare delivery.